癔球症患者食管测压结果、心理特征分析及小剂量阿米替林的干预效果研究

摘要 目的：分析患者的食管测压结果、心理特征及小剂量阿米替林的干预效果。方法：选取2017年5月~2019年5月期间上海市静安区市北医院收治的癔球症患者137例（癔球症组）,另选取同期到上海市静安区市北医院体检的健康志愿者50例（非癔球症组）,比较两组食管测压结果、癔球症症状评分量表（GETS）评分、汉密尔顿抑郁量表-17（HAMD-17）评分、汉密尔顿焦虑量表-14（HAMA-14）评分。按随机数字表法将癔球症患者分为对照组（n=68）和研究组（n=69）,对照组给予常规治疗,研究组则在对照组的基础上联合小剂量阿米替林干预。比较对照组、研究组的临床疗效、不良反应。结果：癔球症组、非癔球症组患者食管上括约肌（UES）长度、UES残余压、食管下括约肌（LES）静息压、收缩前沿速度（CFV）、远端潜伏时间（DL）组间比较差异无统计学意义（P>0.05）;癔球症组患者UES静息压高于非癔球症组（P<0.05）。癔球症组患者GETS、HAMA-14、HAMD-17评分高于非癔球症组（P<0.05）。研究组治疗后的临床总有效率为84.06%（58/69）,高于对照组的66.18%（45/68）（P<0.05）。两组不良反应发生率比较差异无统计学意义（P>0.05）。结论：相对于非癔球症患者,癔球症患者具有较高的UES静息压,癔球症症状及较为严重的不良情绪,采用小剂量阿米替林对癔球症进行干预可提高治疗有效率,用药安全性较好。     

The Crossmodal Congruency Task as a Means to Obtain an Objective Behavioral Measure in the Rubber Hand Illusion Paradigm

The rubber hand illusion (RHI) is a popular experimental paradigm. Participants view touch on an artificial rubber hand while the participants'' own hidden hand is touched. If the viewed and felt touches are given at the same time then this is sufficient to induce the compelling experience that the rubber hand is one''s own hand. The RHI can be used to investigate exactly how the brain constructs distinct body representations for one''s own body. Such representations are crucial for successful interactions with the external world. To obtain a subjective measure of the RHI, researchers typically ask participants to rate statements such as "I felt as if the rubber hand were my hand". Here we demonstrate how the crossmodal congruency task can be used to obtain an objective behavioral measure within this paradigm.The variant of the crossmodal congruency task we employ involves the presentation of tactile targets and visual distractors. Targets and distractors are spatially congruent (i.e. same finger) on some trials and incongruent (i.e. different finger) on others. The difference in performance between incongruent and congruent trials - the crossmodal congruency effect (CCE) - indexes multisensory interactions. Importantly, the CCE is modulated both by viewing a hand as well as the synchrony of viewed and felt touch which are both crucial factors for the RHI.The use of the crossmodal congruency task within the RHI paradigm has several advantages. It is a simple behavioral measure which can be repeated many times and which can be obtained during the illusion while participants view the artificial hand. Furthermore, this measure is not susceptible to observer and experimenter biases. The combination of the RHI paradigm with the crossmodal congruency task allows in particular for the investigation of multisensory processes which are critical for modulations of body representations as in the RHI.     

Incidence and predictors of phantom shocks in implantable cardioverter defibrillator recipients

Background

Implantable cardioverter defibrillators (ICDs) are designed to deliver shocks or antitachycardia pacing (ATP) in the event of ventricular arrhythmias. During follow-up, some ICD recipients experience the sensation of ICD discharge in the absence of an actual discharge (phantom shock). The aim of this study was to evaluate the incidence and predictors of phantom shocks in ICD recipients.

Methods

Medical records of 629 consecutive patients with ischaemic or dilated cardiomyopathy and prior ICD implantation were studied.

Results

With a median follow-up of 35 months, phantom shocks were reported by 5.1 % of ICD recipients (5.7 % in the primary prevention group and 3.7 % for the secondary prevention group; p=NS). In the combined group of primary and secondary prevention, there were no significant predictors of the occurrence of phantom shocks. However, in the primary prevention group, phantom shocks were related to a history of atrial fibrillation (p=0.03) and NYHA class <III (p=0.05). In the secondary prevention group, there were no significant predictors for phantom shocks.

Conclusion

Phantom shocks occur in approximately 5 % of all ICD recipients. In primary prevention patients, a relation with a history of atrial fibrillation and NYHA class <III were significant predictors for the occurrence of phantom shocks. In the secondary prevention patients, no significant predictors were found.     

Neurologically normal development of a patient with severe methionine adenosyltransferase I/III deficiency after continuing dietary methionine restriction

Background

There is not much information on established standard therapy for patients with severe methionine adenosyltransferase (MAT) I/III deficiency.

Case presentation

We report a boy with MAT I/III deficiency, in whom plasma methionine and total homocysteine, and urinary homocystine were elevated. Molecular genetic studies showed him to have novel compound heterozygous mutations of the MAT1A gene: c.191T>A (p.M64K) and c.589delC (p.P197LfsX26). A low methionine milk diet was started at 31 days of age, and during continuing dietary methionine restriction plasma methionine levels have been maintained at less than 750 μmol/L. He is now 5 years old, and has had entirely normal physical growth and psychomotor development.

Conclusions

Although some severely MAT I/III deficient patients have developed neurologic abnormalities, we report here the case of a boy who has remained neurologically and otherwise normal for 5 years during methionine restriction, suggesting that perhaps such management, started in early infancy, may help prevent neurological complications.     

Morningness: Protective Factor for Sleep-Related and Emotional Problems in Childhood and Adolescence?

The relationship between morningness/eveningness, sleep, and psychological problems is well documented in adults as well as in adolescents. However, research on the circadian orientation and its concomitants in younger children is scarce. The authors investigated the distribution of morningness/eveningness and its connection to sleeping and psychological problems in 91 children and 151 adolescents in Austria. The authors found that morning (M) types had less sleep-related and psychological problems than intermediate (I) and evening (E) types, respectively. Among children, M-types suffered less from daytime sleepiness (females: χ²₍₂₎?=?8.1, p?=?.017; males: χ²₍₂₎?=?14.8, p?=?.001). Among adolescents, M-types showed fewer sleep-wake problems (females: χ²₍₂₎?=?17.5, p?<?.001; males: χ²₍₂₎?=?19.8, p?<?.001), and female M-types showed less externalizing (χ²₍₂₎?=?8.7, p?=?.013) as well as internalizing problem behavior (χ²₍₂₎?=?9.0, p?=?.011). In conclusion, these findings indicate that morningness may act as a protective factor against the development of sleep-related problems in childhood and sleep-related and psychological problems in adolescence, especially in females. (Author correspondence: gloriagelbmann@gmx.at)     

白癜风患者求医行为的调查研究

目的:本文的目的是研究白癜风患者的求医行为及男女性别之间的差异,分析患者选择医疗机构的原因并指导他们正确就医.方法:我们对210例白癜风患者进行问卷调查分析.访谈问卷内容包括人口统计学特征、白癜风知识、求医行为及原因、疾病的发展及心理状态的调查等.结果:仅14.3％的患者对自身疾病的基本知识回答正确,并且患者主要通过医生获得疾病知识;81.0％的患者首诊时选择公立综合医院,医疗技术水平(占69.9％)是患者在首诊时选择医疗机构的主要考虑方面,50.5％的患者存在多处求医的现象;81 4％的患者存在不同程度的心理压力.结论:白癜风患者普遍存在多处求医及不良求医行为,公立医院是目前白癜风患者的主要流向;白癜风患者的认知程度、心理状态等不容乐观;我们应针对白癜风患者多次求医和乱求医的行为及其原因开展白癜风健康教育,正规医疗机构应通过改善服务质量、提高疗效、加强宣传等促进白癜风患者正确求医.     

手术室术前访视应用ipad对访视效果影响的研究

目的：探讨术前访视应用ipad在术前访视中对手术患者心理状态的影响。方法：将300例择期手术患者随机分为对照组（150例）和实验组（150例）,对照组采用常规术前访视方案;实验组在此基础上结合ipad展示围术期相关信息,采用焦虑自量表评估两组病人入院时和入手术室时的焦虑状况及血压、心率等指标,并且进行术后并发症和满意度的调查。结果：改良术前访视后焦虑评分、收缩压、舒张压、心率实验组明显低于对照组。结论：术前访视应用ipad可明显减轻手术病人术前的焦虑。     

牙科焦虑症治疗方法综述

牙科焦虑症主要是对疼痛的恐惧、对未知的恐惧、对机体受到伤害的恐惧等因素导致的焦虑症状。临床中80%的口腔疾病患者都对治疗心存恐惧,因此在很大程度上不能配合医生的治疗甚至逃避治疗。随着生活水平的不断提高,人们要求在舒适的心理环境中接受治疗,因此牙科焦虑症就成为口腔医护工作者必须面对的问题。治疗牙科焦虑症的方法主要分为行为学,药理学和有机放松法三个大类,在实际使用的过程当中往往是各种方法配合使用,而不是单一使用。随着人们研究的逐步深入,提出的具体治疗方法也越来越多,本文就牙科焦虑症目前所使用的治疗方法做详细的介绍及分类,帮助口腔医护工作人员理清治疗思路,为正确的诊断、干预和治疗牙科焦虑症提供治疗方法。     

Psychological distress and personality factors in takotsubo cardiomyopathy

Background

Takotsubo cardiomyopathy (TCC) is a transient condition characterised by severe left ventricular dysfunction combined with symptoms and signs mimicking myocardial infarction. Emotional triggers are common, but little is known about the psychological background characteristics of TCC. This study examined whether patients with TTC have higher levels of psychological distress (depressive symptoms, perceived stress, general anxiety), illness-related anxiety and distinct personality factors compared with healthy controls and patients with heart failure.

Methods and Results

Patients with TCC (N = 18; mean age 68.3 ± 11.7 years, 77.8?% women) and two comparison groups (healthy controls: N = 19, age 60.0 ± 7.6, 68.4?% women and patients with chronic heart failure: N = 19, age 68.8 ± 10.1, 68.4?% women) completed standardised questionnaires to measure depression (PHQ?9), perceived stress (PSS-10), general anxiety (GAD-7), illness-related anxiety (WI-7) and personality factors (NEO-FFI and DS-14). Psychological measures were obtained at 23 ± 18 months following the acute TTC event. Results showed that patients with TCC had higher levels of depressive symptoms (5.2 ± 5.2 vs. 2.5 ± 2.4, p = 0.039) and illness-related anxiety (2.1 ± 1.7 vs. 0.7 ± 1.3, p = 0.005) compared with healthy controls. Patients with TCC did not display significantly elevated perceived stress (p = 0.072) or general anxiety (p = 0.170). Regarding personality factors, levels of openness were lower in TCC compared with healthy controls (34.2 ± 4.3 vs. 38.2 ± 5.6, p = 0.021). No differences between TCC and heart failure patients were found regarding the psychological measures.

Conclusions

TCC is associated with higher levels of depressive symptoms, more illness-related anxiety and less openness compared with healthy controls. These data suggest that TCC is associated with adverse psychological factors that may persist well after the acute episode.